Fluoride and bone: a second look. No use in osteoporosis.

(1) Data on fluoride efficacy in secondary prevention of osteoporotic fractures were contradictory when we last examined the file, in 1990. We now re-examine the clinical file on fluoride with more follow-up and new clinical trial data. (2) In 354 postmenopausal women with a history of vertebral fracture (secondary prevention), a comparative trial (the FAVOS trial) showed that moderate-dose fluoride for 2 years did not reduce the incidence of new vertebral fractures relative to calcium plus vitamin D. Furthermore, fluoride caused more cases of lower-limb pain. (3) In 110 postmenopausal women with a history of vertebral fracture, a trial showed that fluoride (sustained-release form) + calcium was more effective than calcium alone in preventing vertebral fractures. (4) No pertinent trial on fluoride in primary prevention has been published since 1991.